British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pulmonary function after laparoscopic and open cholecystectomy.
In this prospective, randomized study, we compared 42 patients undergoing laparoscopic cholecystectomy and 40 undergoing open cholecystectomy to determine if laparoscopic cholecystectomy results in less respiratory impairment and fewer respiratory complications. Pulmonary function tests, arterial blood-gas analysis and chest radiographs were obtained in both groups before operation and on the second day after operation. Postoperative pain scores and analgesic requirements were also recorded. ⋯ The reductions in FRC, FEV1, FVC and FEF25-75% were smaller after laparoscopic (7%, 22%, 19% and 23%, respectively) than after open (21%, 38%, 32% and 34%, respectively) cholecystectomy. Laparoscopic cholecystectomy was also associated with a significantly lower incidence (28.6% vs 62.5%) and less severe atelectasis, better oxygenation and reduced postoperative pain and analgesia use compared with open cholecystectomy. We conclude that postoperative pulmonary function was impaired less after laparoscopic than after open cholecystectomy.
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Comparative Study
Efficacy of intraoperative heat administration by ventilation with warm humidified gases and an oesophageal warming system.
We measured changes in body temperature in 12 hypothermic (mean aural temperature 34.4 (SD 1.0) degrees C) pigs during general anaesthesia with an open abdominal cavity and the effect of two warming systems: heating of inspired gases to 39 degrees C (intratracheal temperature) and oesophageal warming to 39 degrees C by a water perfused oesophageal heat exchanger. Each animal underwent both treatments and the control period in random sequence. Each condition was studied over 1 h. ⋯ Anaesthesia, room temperature and relative humidity, amount and temperature of infusions and extension of exposed visceral surfaces were standardized. Mean decrease in body temperature was 1.0 (0.7) degree C (P < 0.005) without warming and 0.6 (0.2) degree C (P < 0.005) with heated inspired gases: this difference was not statistically significant. Oesophageal warming was very efficient as mean body temperature did not change significantly (-0.1 (0.2) degree C; ns).
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We describe the use of heparinase-guided thrombelastography in the assessment of a parturient who had been anticoagulated with heparin for suspected thromboembolic disease. Reversal of the heparin effect in the heparinase-treated sample facilitated administration of protamine and successful subarachnoid analgesia for delivery.
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We have studied the influence of motivation of care providers on the incidence and duration of postoperative hypoxaemia in the recovery room. In a prospective, switch-back designed cohort study, we have compared the incidence of low pulse oximeter saturation values (SpO2) during pre-intervention, intervention and post-intervention phases. Low SpO2 values were classified as either hypoxaemia (SpO2 < or = 90%, minimum duration 1 min) or artefact. ⋯ The number of patients who had severe hypoxaemia for more than 5 min decreased from 13 to 1 (RR 0.08, CI 0.02-0.36; P < 0.01). In the post-intervention period, the incidence of hypoxaemia returned to pre-intervention values. The results of this study suggest that motivation of care providers to prevent and treat low SpO2 is an important determinant of postoperative hypoxaemia in the recovery room.
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We report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser.